The deliverability is of course very important, and this is where stents have improved the great deal so not only the stent thickness but the shaft, the way the stent is crimped on the balloon, everything has changed. So, the stents are getting easier and easier to deliver.

Multi-vessel Coronary Artery Disease : Trends in IndiaClearly in India especially the multi vessel disease is growing rapidly. This is primarily because the Indians get the disease at a younger age. So, if somebody picks it up at the age of 35 or 40, by the time he gets to 80 it's always going to be multi vessel disease. Clearly, it’s something which is very important for this country.

Complex Coronary Artery : disease managementYes, when we talk of coronary artery disease, we always have three important options do aggressive good medical therapy, alternatively you must do an intervention which may be in terms of an angioplasty or a bypass surgery.

All are important. Generally, I would imagine that when you sit in a car you put your seatbelt that's like taking care and taking aggressive medical therapy and continuing. But when an event happens the air bags come out so the angioplasty or a bypass surgery is like an emergency measure where artery or a person who is on a downward trend comes out very effectively and is ready to live effective life subsequently.

Patients’ clinical outcome : quality of life-saving medical devices As an intervention cardiologist this is something which is extremely important. Patient has lots of questions. They would obviously want to have the least traumatic kind of therapy to them. So, the surgeons are now moving from a regular surgery to a mini cut surgery, a micro invasive surgery. We as angioplasters we never cut anything no stitch when we do an angioplasty procedure.

We are also spreading our wings to multi vessel disease, complex coronary angioplasties. So, for this you need a good support. So initially like say we use to have aortic balloon pump for somebody who had low blood pressure. Today, we have few devices like Ampyra, which make life very easy for angioplaster to give effective results.

More importantly, a conventional angioplasty can be perfected by doing testing at the end of the procedure. This can be done at the beginning of the procedure and repeated at the end of the procedures so we are talking of IVUS or OCT and this is to decide what kind of therapy we should be using. We have multiple options not anymore just balloon and stent.

It could be cutting balloon or scoring balloon or shockwave balloon or high pressure non-compliant balloon and so on. Also, there are procedures which soften a harden vessel which is so very crucial for a good stent placement. All these techniques can be implemented in each case according to the need and this is brought out by imaging before.

Imaging at the end of the procedure tells you that whether your stent is very effectively placed in a vessel, the result is acceptable, it will go for years and years very effectively.

So, either way, the patient gains substantially with combination of imaging and physiology. Absolutely, if you will see the evolution of angioplasty world over and especially in India, where we started doing angioplasty in 1987. It’s almost three decades of angioplasty in India and we clearly realise that we were doing early in early years and the way we are doing today the newer technology has clearly benefitted. We are so confident. In fact, this debate comes up when we talk of the comparison for multi vessel disease between bypass surgery on one side and angioplasty on the other side. Innovation in medical devices : improved successWe have this SYNTAX study earlier which clearly indicated that if you have a high SYNTAX score or moderate SYNTAX score surgery is better. Same SYNTAX few years later was done as SYNTAX tool in which lot of physiology was used and lot of imaging was used and that clearly shows that angioplasty results can be very close to the surgical results. So, this is the kind of gain we have gained while perfecting the angioplasty with imaging and physiology.

Choice of stent : Who decides ?When I am talking to the patient and its family. What kind of stents? We tell them that this this this is available to you and I clearly tell them no one stent is the best in the world for everybody. It depends a lot on what kind of linear stent that you need from the stent, what kind of tortuosity through which the stent must go. It’s the bed which is simple or difficult. The stent performance can change so we always take a lot of effort to create a good bed for the stent to land.

So, today stents performed well. The deliverability is of course very important, and this is where stents have improved the great deal so not only the stent thickness but the shaft, the way the stent is crimped on the balloon, everything has changed. So, the stents are getting easier and easier to deliver. Also, we have techniques like Guide Catheter Extension which can help you to take the stent to a correct location relatively easily and that's how the stent delivery is not any more an issue.

However, the stent will have its own sort of specifications, which make them run for longer years and this is where I would feel I tell the patients that this particular stent has this much documentation, this much data and this is going to be my choice for your case and it depends on person to person and patient to patient.

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When the blood reaches these curves, it makes changes to its fluid mechanics and interactions with the vessel wall. In a healthy person, these changes are in harmony with the tortuous microenvironment, but when diseased, these environments could lead to very complex flow conditions that activate proteins and cells that eventually lead to blood clots.